Concierge doctors

[Hobson]

Mr. H's PCP is going to convert to a concierge practice. The doctor is staying where he is, but will be charging a $2,100 per year fee just to stay with him as a patient. He wants to drop from 1,500 patients to 600 and getting enrolled is on a first come basis. We can afford the fee and Mr. H really likes the doctor and has been seeing him for years. So he signed up.

I started thinking that 900 patients will have to find a new PCP and that's not easy.

I see a different PCP in the same group practice. So far there has been no mention of him changing to concierge. But I can see that it might happen.

Supposedly you get easier access to appointments and can call the doctor on a cell number and he'll answer. Supposedly you get more personalized health care. I wonder. Anybody here have experience with concierge doctors?

[Marty]

$2,100. X 600 is $1,260,000.   And that's before office charges.

Now why didn't I think of that. I could cut down on the number of clients I see with a yearly fee and still charge for my work.

If I charged a reasonable yearly fee and only kept so many clients I could work less on other peoples guitars and more on my own projects.

[Dub]

That’s a new one on me. The only way I’d go for that is if everything was covered by plans.

I’m on Medicare and a Plan F supplemental. Other than premiums, I don’t pay anything. I have no restrictions and don’t need a referral to see the specialist of my choice.

[aquaduct]

I've been reading about that along with all the long term follow on problems that have come out of Obamacare. The main one being corpratization. Then was a provision in Obamacare (can't remember details now) but it was meant to cap costs and ended up merging everything and cutting availability of everything from doctors to hospitals.

Being a diabetic, I'm seeing it in spades.

My endocrinologist is the only one within about 60 miles I think. My guess is he will have to go concierge soon to simply keep his sanity.

And then I'm dependent on a Dexcom device. A stone miracle for a diabetic.

Been having an absolute nightmare getting supplies for the last 9 or 10 months.

In September I was trying to reorder and they needed a prescription. So I had to hand walk the process through roughly a month of dumb f'ups on the suppliers part.

So I tried all the alternatives. Maybe I can get it from a regular pharmacy. Nope, not if I want our insurance to cover it. It's got to be a durable medical goods supplier.

Called Solara (the f'ing supplier) and talked to one of the rotating crew of Pakistanis who barely speak English one Tuesday night and he assured me it would be here overnight which I assumed was Wednesday. Then he started referring to Thursday when it would be here. So I stopped him and asked where he was at that moment. The Philippines. Ah! Time zone trouble. Didn't matter in the end because nothing showed up Thursday either. Nor Friday. Nor Monday.

Later one of phone answerers transferred me to Dexcom directly. He was an American technician and gave me another number to call to find a better supplier.

So I did. To make it short, big zero there. Then I called our insurance to see if they could help.

She called me back and offered 2 numbers, one of which has a warehouse operation in Winchester. Awesome!

Call up and find out the company sales offices are in Harrisonburg. Okay, I'll bite.

Well they farm some stuff like Dexcom through a sub supplier, "Let me transfer you."

Ring, ring..... "You have reached Solara Medical Supply...."

At that point I literally wept. Wife took pity on me and found an outfit in New Jersey that would sell me my supplies without a prescription (and of course without insurance).

A couple weeks later one of the foreign automatons called me and asked if I wanted to refill my prescription. I purposely with all my might politely asked for a manager. Instead of saying that the entire management of the company was in training and couldn't be bothered like usual, she said she'd have a manager call me back.

Surprisingly, a manager did. She actually listened to me as I cursed a blue streak and she took notes. And my supplies showed up a few days later.

Just went through it again and things seemed to have improved for now.

But good lord, the medical profession seems to be up to its ass in alligators these days.

Thanks Barry. Love ya, mean it.

[Hobson]

I'm hoping that $2,100 per year gets Mr. H some help with hassles about getting prescriptions approved, getting in to see specialists, maybe getting more than a few minutes with the PCP and actually discussing how to stay healthy, getting tests that he needs, etc. We'll see. We elected to pay for one quarter and we'll take it from there.

But I agree that health care in this country is not what it should be. And I don't like the idea that you can buy your way into what it should be. And insurance providers shouldn't be making medical decisions unless there's some obvious fraud or over-prescribing. OTOH, it seems pretty easy for fraudsters to sneak things by Medicare. I had so many fraudulent claims that I ended up getting a new Medicare number. If I hadn't taken the initiative to call Medicare on three different occasions regarding multiple claims each time and work my way through the long process process of reporting them, it would still be happening.

[Russell Letson]

Peter, I'm not in a position to know the details of your particular situation, but what I've seen in St. Cloud--since well before Obamacare--has been consolidation of at least two kinds. One nominally non-profit organization (CentraCare) has hoovered up nearly every medical practice and specialty, starting with the local hospital and extending to small primary-care practices to imaging/radiology to pharmacies to nursing homes.

The practice of our original doctor--48 years ago, he was one of the hot young internists in town--was acquired by CentraCare, and he seemed to me to become increasingly impatient with the management overhead and retired a bit early. I quite liked his (also CentraCare-employed) successor, but I was also annoyed by the big-organization stuff, so we switched to a smaller-but-substantial group and were quite content, until they sold themselves to CentraCare. Now, CentraCare is very good at medical stuff--everybody we've dealt with has been competent and pleasant, and the hospital's reputation is very high (especially for cardiac care). Nevertheless, despite improvements in its record-keeping system (our old doc and I went through the teething period of electronic-records adoption--"You're not diabetic. How did that get in there?"), the business end still feels like a big bureaucratic machine. And the protocols for something as straightforward as an annual exam mean that the doc has about 20 minutes with me, and should I ask a question that's not on the checkoff list (and I'm not Medicare patient), it generates a separate office-visit charge. First time that happened, I'd asked about my blood pressure and found a $285 charge for what was supposed to be a covered annual checkup. Arguing with the billing people did no good--it was coded as a separate encounter and billed accordingly.

I doubt that much of that has anything to do with Obamacare or low Medicare reimbursement. Though the rules and rates that result from negotiations with insurance companies might. And that doesn't address the effects of private-capital acquisitions of ERs, ambulance/EMT services, and various specialty practices (anaesthesiologists, for example). (Dental and veterinary practices, too.) What all those have in common is the view of medicine as a surefire way to make lots of money from a market in which demand is essentially infinite.

[factorychef]

I've never had any problems with my Health care providers or prescriptions.I have diabetes and 1 kidney that is working on the low end.I used to pay 44.00 a month for my prescription drug plan an a Snap lady changed me over to a great plan that costs this 77 year old man 6.00 total a year. I also have schedule F for health insurance.

[Marshall]

Do you get chocolates on your exam table with Concierge service?


Medicine is becoming corporatized, as you say. Individual practitioners are becoming a thing of the past. Now days you're part of a "Group." Individual practices are bought up by a Health Group associated with a Hospital Group. Drs become employees of the Group. A lot of foreign Drs become your primary care people. My long time GP, who is 10 years younger than I, just retired. He was part of partnership practice years ago that sold out to the big local hospital health group. He stuck around for 10 years or more until he just retired. Now I see a nice middle aged Pilipino lady Dr. She seems nice and competent.

I believe in urban areas, the new model is working as well as can be expected. In more rural areas, I expect that the availability of care will become strained, as there isn't enough critical mass to support a full practice service out there.

Some friends of ours retired and moved to northern WI. He always wanted to live up north on a lake. They've got enough dough to pull it off. They built a very nice house on 10 or 15 acres. A quarter mile long driveway. He's got his own plow and massive snow blower.

But he has a bad heart condition. And his long term specialist is still in Chicago area. We heard recently that he found another local specialist up there he likes, that is only a 3 hour drive away (with clear roads)

Seems crazy to me.

[Marshall]

Just wait until AI takes over our health care. It'll put the Philipino doctors out of work.

[theevan]

It's a trend here. My PCP went concierge with the Advent of Obamacare. I bailed.

Since I haven't used medical care other than annual physical and my half-decade roto-rooter, I don't need that kind of access.

If I turn a corner and need ongoing prescriptions and so on I would consider it.

[billhammond]

< Filipino >

[John B]

If you have insurance through you employer, and you've changed jobs in the last 10 years, you most likely would have lost coverage for any pre-existing conditions without Obamacare.

Need any mental health coverage? It might not have been covered at all prior to Obamacare.

Kid turns 21? Off your policy pre-Obamacare. Many folks would prefer their kids not stay on their policy until age 26, but a lot of folks see it as a benefit.

I couldn't change jobs in early 2012 because I couldn't afford obtaining my own health insurance policy - the new employer didn't offer insurance, there was no national marketplace (it didn't roll out until late 2012 or 2013, I think), and the prices for the private health insurance absorbed a substantial part of what my paycheck would have been. I stayed with my employer at the time (GC) because they offered health insurance.

[Marshall]

Apr 2, 2024 15:29:43 GMT -5 billhammond said:

< Filipino >

From the Fillipeans then.

[Cornflake]

I want to get into the Mayo Clinic. The doctors there have been returning phone calls for a long time. By all accounts the care is excellent.

Alas, Mayo won't take Medicare unless you have something seriously wrong that they happen to be interested in. If you don't, you have to pay rates that are geared to the rich.

[kenlarsson]

Military retirement medical coverage has proven to be a bigger benefit than the paycheck. I've got Medicare A & B and Tricare for Life. And, while the VA was terrible when I retired, they've improved thanks to John McCain, and I've been very impressed with the treatment I've gotten in getting hearing aids.

[TKennedy]

I still have my medical license. I’m hopelessly out of date as far as current practice but I’d be willing to do 10 zoom appointments a year for $29.99 if you act in the next 15 minutes. Be advised that I let my narcotics number lapse.

[coachdoc]

Apr 2, 2024 18:01:20 GMT -5 TKennedy said:

I still have my medical license. I’m hopelessly out of date as far as current practice but I’d be willing to do 10 zoom appointments a year for $29.99 if you act in the next 15 minutes. Be advised that I let my narcotics number lapse.

Ditto.

[Dub]

We are lucky in Cedar Rapids. Mercy Medical Center where Todd was and where I go if necessary is an independent hospital and one of the finest in the state and the nation. It ranks with the University of Iowa Hospitals and Clinics (UIHC) and is often rated first in the state. It is operated by the Sisters of Mercy and is not part of any national or regional “Mercy” organization.

My PCP is an internist and part of the local Marcy Care group, again independent of any larger organization. My medical plan allows me to go to any doctor who will take me.

Fiddlerina was retired from the Air Force for medical reasons and has full medical coverage through them. The VA clinic in Iowa City is associated with UIHC and the care there is among the nation’s best.

Any time my doctor or dentist become part of a larger company, I find a replacement.

[howard lee]

Apr 2, 2024 15:53:41 GMT -5 John B said:

[...] I stayed with my employer at the time (GC) because they offered health insurance.

That's one of the reasons I stayed with the stupid job I had for 17 years. We needed the health insurance for the girls; my wife is an independent contractor so my plan covered her and my daughter. That company had a pretty decent health plan because many of my coworkers from that community have anywhere between seven and 21 children per family. (There were lots of "charity" jobs.)

Now we are looking into a new plan for the girls.